Pediatric and Obstetrical Anesthesia: Papers presented at the 40th Annual Postgraduate Course in Anesthesiology, February 1995 PDF
Preview Pediatric and Obstetrical Anesthesia: Papers presented at the 40th Annual Postgraduate Course in Anesthesiology, February 1995
PEDIA TRIC AND OBSTETRICAL ANESTHESIA DEVELOPMENTS IN CRITICAL CARE MEDICINE AND ANESTHESIOLOGY Volume 30 The titZes published in this series are listed at the end 0/ this volurne. PEDIATRIC AND OBSTETRICAL ANESTHESIA Papers presented at the 40th Annual Postgraduate Course in Anesthesiology, February 1995 edited by T. H. ST ANLEY AND P. G. SCHAFER University of Utah School of Medicine, Department ofA nesthesiology, Salt Lake City, Utah, Us.A. SPRINGER SCIENCE+BUSINESS, MEDIA, B.V. A C.I.P. Catalogue record for this book is available from the Library of Congress. ISBN 978-94-010-4141-6 ISBN 978-94-011-0319-0 (eBook) DOI 10.1007/978-94-011-0319-0 Printed on acid-free paper AII Rights Reserved © 1995 Springer Science+Business Media Dordrecht Origina11y published by Kluwer Academic Publishers in 1995 Softcover reprint of the hardcover 1s t edition 1995 No part of the material protected by this copyright notice may be reproduced Of utilized in any form or by any means, electronic or mechanical, including photocopying, recording Of by any information storage and retrieval system, without written permission from the copyright owner. TABLE OF CONTENTS Physiologie Adaptation During Pregnancy G. W. Ostheimer Cardiac Disease in Pregnancy S. L. Clark 27 Anesthesia for Severe Preeclampsia C. P. Gibbs 51 Effects of Pregnancy on Local Anesthetic Aetion and Toxicity M. Finster 65 Obstetrie Emergencies C. P. Gibbs 69 Anesthesia for Surgery in the Pregnant Surgical Patient A. M. Malinow with J. W. Ostheimer (ed.) 79 Fetal Considerations in the Critieally III Obstetric Patient J. P. Phelan with S. L. Clark (ed.) 89 Does Epidural Analgesia Prolong Labor and Increase the Incidence of Instrumental or Operative Delivery? M. Finster 117 Anesthesia for the Inner-City Parturient D. J. Birnbach 123 Aspiration: Etiology, Prevention, and Treatment C. P. Gibbs 133 Combined Spinal/Epidural Anesthesia (CSE) for Labor and Delivery D. J. Birnbach 151 Resuscitation of the Newborn G. W. Ostheimer 159 Neonatal Physiology of Importanee to the Anesthesiologist F. A. Berry 187 Anesthesia for the Neonate: Emergent and Non-emergent J. M. Badgwell 197 Fasting and Premedication in Infants and Children J. Lerman 215 vi Anesthesia for the Ex-premature Infant J. M. Badgwell 229 Management of the Difficult Pediatric Airway F. A. Berry 245 Muscle Relaxants in Infants and Children D. R. Cook 253 New Inhalational Anesthetics in Infants and Children J. Lerman 265 Stress Responses in Pediatric Anesthesia P. R. Hiekey 277 Perioperative Fluid and Blood Volume Management in Infants and Children D. R. Cook 283 Regional Anesthesia in the Pediatric Patient L. J. Riee 291 Postoperative Nausea and Vomiting in Children J. Lerman 303 An Update on Malignant Hyperthermia and Duchenne's Muscular Dystrophy F. A. Berry 315 Pediatric Outpatient Anesthesia R. S. Hannallah 323 Anesthetic Considerations in Congenital Heart Disease P. R. Hiekey 335 Ketamine - From "Star Wars" to Dinosaur in 25 Years? L. J. Riee 345 Current Status of Intravenous Anesthesia in Children R. S. Hannallah 357 Postoperative Pain Management in the Pediatric Patient L. J. Riee 363 Preface Pa trick G. Schafer, M.D. Pediatric and Obstetrical Anesthesia contains the Refresher Course manuscripts of the presentations of the 40th Annual Postgraduate Course in Anesthesiology which took place at The Cliff Conference Center in Snowbird, Utah, February 24-28, 1995. The chapters reflect recent advances in the physiology, pharmacology, and anesthetic management of patients with central nervous system disease. There are also chapters which deal with central nervous system trauma and with brain protection. Each of the chapters is written by an authority in the field and has been edited only to the extent that was necessary to produce a coherent book. No effort has been made to provide a uniform presentation or style. The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is abrief but sharply focused glimpse of the interests in anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the thirteenth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. VB LIST OF CONTRIBUTORS J. Michael Badgwell, M.D. Department of Anesthesiology, Texas Tech University Health Sciences Center, Lubbock, Texas, U.S.A. Frooeric A. Berry, M.D. Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, Virginia, U.S.A. David J. Birnbach, M.D. Department of Anesthesiology, Columbia University, St. Luke's - Roosevelt Hospital Center, New York, New York, U.S.A. Steven 1. Clark, M.D. Department of Perinatology, LDS Hospital, Salt Lake City, Utah, U.S.A. D. Ryan Cook, M.D. Department of Anesthesiology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. Mieczyslaw Finster, M.D. Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A. Charles P. Gibbs, M.D. Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, Colorado, U.S.A. Raafat S. Hannallah, M.D. Department of Anesthesiology, George Washington School of Medicine, Children's Hospital, Washington, D.C., U.S.A. Paul R. Hiekey, M.D. Department of Anesthesia, Harvard Medieal School, Children's Hospital, Boston, Massachusetts, U.S.A. Jerrold Lerman, M.D., FRCPC Department of Anaesthesiology , Hospital for Siek Children, Toronto, Ontario, Canada Andrew M. Malinow, M.D. Department of Anesthesiology, University of Maryland Medical System, Baltimore, Maryland, U.S.A. ix x Gerard W. Ostheimer, M.D. Department of Anesthesia, Harvard Medical Sehool, Brigham and Women's Hospital, Boston, Massaehusetts, U.S.A. Jeffrey P. Phelan, M.D. Department of Anesthesiology, Queen of the Valley Hospital, West Covina, California, U.S.A. Linda J. Riee, M.D. Department of Anesthesia, Hartford Hospital, Hartford, Conneeticut, U.S.A. PHYSIOLOGIC ADAPTATION DURING PREGNANCY G. W. Ostheimer Pregnancy involves major physiologie and anatomie adaptation by a11 of the maternaiorgan systems. The anesthesiologist caring for the pregnant patient must und erstand these physiologie changes in order to provide safe analgesia and anesthesia to the mother and enable safe deli v ery of the fetus. CARDIOVASCULAR SYSTEM CARDIAC OUTPUT Oxygen consumption increases du ring pregnancy, and maternal cardiac output rises to meet the demand (Table 1) (1). The rise in cardiac output is a result of increased heart rate and decreased afterload, as stroke volume does not change appreciably during normal pregnancy (2). Cardiac output rises most rapidly during the second trimester (Figure 1) and then remains steady until term, when labor and uteroplacental trans fusion of blood into the intravascular system cause further increase in cardiac output. BWOD VOLUME Blood volume increases by 35% during pregnancy compared with the nonpregnant state (3). The stimulus for this change is controversial. Increased mineralocortieoid levels d uring pregnancy may predispose to progressive sodium and water retention with consequent enlargement of the intravascular space (the "overfill" hypothesis). Alternatively, primary enlargement of this space owing to hormonal (prostaglandin, proges terone) vasodilation and placental arteriovenous shunting may be the stimulus for secondary renal sodium and water retention (the "underfill" hypo thesis) (4). Recent evidence seems to favor primary peripheral vasodilation early in the first trimester (underfill) as the cause of subse quent blood volume expansion (5). T.H. Stanley and P.G. Schafer (eds.), Pediatric and Obstetrical Anesthesia, 1-26. © 1995 Kluwer Academic Publishers.
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